-- Periods of depression. These days are generally spent in sadness and helplessness. I do not have any desire to leave the house at all. If I do leave the house, I am very anxious when I am around people. I fear judgment and there is a sense of paranoia -- I feel that most people are to be mistrusted. The anxiety in social situations has always been present, but the depression has gotten worse of the past couple of years.

-- I experience short bursts of happy moods and a general return to "normal." During these times I am more apt to leave the house and I feel a lot more comfortable around people -- I'm much more talkative, and my attention span actually improves somewhat. Also during these times there is a higher propensity for me to be creative (write and play music, paint, write poetry, etc). These periods are very short and are far and few between. These symptoms have become more apparent as my depression has gotten worse.

-- I have a very short attention span. I'm very forgetful and I sometimes blank out when someone is talking to me. If I hear outside noises when I am talking or doing something, I cannot function. If I am not interested in something, I can't pay any attention to it. If I am interested, I am 100% immersed in that interest. My grades reflect this in that if I am interested in the subject, I usually get A's and B's. However, most of my grades are very poor. These symptoms have been present for my entire life.

-- I suffer from mood swings quite often. I can be very irritable and prone to showing my temper. Although I have always been moody, I used to be able to contain my anger. However, over the past year I have lost the ability to do so as my mood swings have become stronger.

I have seen a couple of psychiatrists and have been on a couple of meds. A couple of diagnoses where made, but there was never any resolution. I am wondering if those diagnoses where correct at this point, so I am not even going to name them right now. I just want to start fresh (especially because new symptoms have come up over the past year). I am planning on seeing a new psychiatrist in the near future, so I am not seeking a set diagnosis from you guys. But I am interested in getting as many opinions as possible as to what diagnosis (or diagnoses) I may have. Any help would go a long way towards helping my recovery.

My initial impression is that you may have bipolar disorder along with an attention deficit disorder. These two illnesses do tend to go with one another, and they also tend to run in families.

The symptoms you have described almost fit bipolar disorder right out of the manual, with only a few exceptions. Otherwise, the cycles you report, and the widening gap between up and down periods is consistent with bipolar disorder.

The fact that you are 23 and your symptoms have begun to become worse is also very consistent with bipolar disorder.

I think it would behoove you greatly to find a psychiatrist now, rather than later, because you mentioned some symptoms of paranoia. Many who have bipolar disorder will experience psychosis (a general term for paranoia, hallucinations, delusions), which is a potentially devastating symptom. The latest research suggests that psychosis is damaging to the brain. What happens is that when someone becomes psychotic, an inflammatory reaction occurs in the brain. After the psychosis is resolved, the brain can partially recover from the inflammation, but not completely. Thus, every time you experience psychosis, you also suffer brain damage from inflammation.

We don't completely understand why this happens, or all the details about its occurrence. What we do know is that there is a higher-than-normal amount of inflammatory chemicals in the cerebrospinal fluid of people who have recently been psychotic. You should take steps to stop any psychotic symptoms as soon as they begin, and treating the symptoms of mood instability will help make the psychosis less likely to occur.

Your remarks about your ability to focus when the subject is something you are very interested in is classic for attention deficit problems. Usually, the hyperactive form of ADD has the most trouble with what we call "hyperfocus," the ability to immerse oneself 100% for prolonged periods of time, but only very selectively.

Although this condition (Bipolar + ADHD) is a very serious psychiatric illness, don't be overly alarmed and don't lose hope for your future. You can have a "normal" or even extraordinary life with great accomplishments. Bipolar disorder and ADHD are both correlated with high intelligence. Many great artists, musicians, and scientists of the past who had documented psychiatric illness complete with hospitalizations almost certainly had this problem. Today, there are many very talented and intelligent individuals who have documented bipolar disorder.

I have been diagnosed with ADD by 2 MD's, but never with BPD (but that's because I haven't seen a psychiatrist in a couple of years). I will make an appointment soon.

As for the psychosis, that is one thing that is not present. I have had paranoia since I was about 14. It got really bad in HS -- to the point where I felt that people sitting behind me could read my thoughts. I don't have it that bad anymore, but there is still a sense of paranoia there. Is it possible that this is due to some sort of social phobia? Also, it's worth mentioning that I have never experienced any hallucinations.

I must say that I do have a fear of being schizophrenic because of the paranoia and the lack of close relationships. This is one diagnosis I would love to have ruled out.

Again, thanks for your help!

Best,

F23

Dr. K. Eisele wrote:Dear Freedom:

My initial impression is that you may have bipolar disorder along with an attention deficit disorder. These two illnesses do tend to go with one another, and they also tend to run in families.

The symptoms you have described almost fit bipolar disorder right out of the manual, with only a few exceptions. Otherwise, the cycles you report, and the widening gap between up and down periods is consistent with bipolar disorder.

The fact that you are 23 and your symptoms have begun to become worse is also very consistent with bipolar disorder.

I think it would behoove you greatly to find a psychiatrist now, rather than later, because you mentioned some symptoms of paranoia. Many who have bipolar disorder will experience psychosis (a general term for paranoia, hallucinations, delusions), which is a potentially devastating symptom. The latest research suggests that psychosis is damaging to the brain. What happens is that when someone becomes psychotic, an inflammatory reaction occurs in the brain. After the psychosis is resolved, the brain can partially recover from the inflammation, but not completely. Thus, every time you experience psychosis, you also suffer brain damage from inflammation.

We don't completely understand why this happens, or all the details about its occurrence. What we do know is that there is a higher-than-normal amount of inflammatory chemicals in the cerebrospinal fluid of people who have recently been psychotic. You should take steps to stop any psychotic symptoms as soon as they begin, and treating the symptoms of mood instability will help make the psychosis less likely to occur.

Your remarks about your ability to focus when the subject is something you are very interested in is classic for attention deficit problems. Usually, the hyperactive form of ADD has the most trouble with what we call "hyperfocus," the ability to immerse oneself 100% for prolonged periods of time, but only very selectively.

Although this condition (Bipolar + ADHD) is a very serious psychiatric illness, don't be overly alarmed and don't lose hope for your future. You can have a "normal" or even extraordinary life with great accomplishments. Bipolar disorder and ADHD are both correlated with high intelligence. Many great artists, musicians, and scientists of the past who had documented psychiatric illness complete with hospitalizations almost certainly had this problem. Today, there are many very talented and intelligent individuals who have documented bipolar disorder.

The psychosis I was referring to was the paranoia. What you describe is not exactly psychotic, but it is a prodrome of psychosis. Do not worry, this doesn't mean you will necessarily have psychosis, but it suggests that you might, someday. Delusions are a form of psychosis that not everyone is familiar with. A delusion is a fixed, false belief. You described "feeling" that people behind you could read your thoughts. This is not a delusion, but a paranoid ideation. An occasional paranoid ideation is part of normal life that everyone experiences sometime. When it affects your ability to function, however, at work, home, school, with friends, then it becomes something a little more.